Inadequate health literacy skills are common and associated with poor health outcomes. Heart failure is an important cause of morbidity and mortality. Heart failure disease management programs that focus on building self-management skills can reduce rates of hospitalization. Our pilot randomized trial suggests that patients with inadequate literacy may derive greater benefit from such programs than patients with adequate literacy. We aim to examine, in a multi-site randomized trial, whether a literacy-sensitive intervention to improve heart failure self-management skills can improve health outcomes for all patients, and particularly those with inadequate literacy. We will conduct a multi-site randomized trial of 600 patients with heart failure to determine whether a literacy-sensitive, multi-session intervention that teaches essential self-care skills until patients reach behavioral goals (Teach to Goal) is superior to a Brief Educational Intervention (BEI) consisting of a single educational session, for the outcomes of incidence of hospitalization or death and heart failure-related quality of life over 12 months. We will also examine differences in the proportion of patients achieving appropriate HF-related self-care knowledge and behaviors, and will examine the effect of TTG for patients with adequate and inadequate literacy separately. [unreadable] [unreadable] [unreadable]